Post-operative tracheitis in the NICU: incidence and risk factors

To describe the incidence and risk factors of tracheitis following tracheostomy placement in infants.

We performed a 14-year (2010-2023) retrospective cohort study of infants with a tracheostomy placed in a Level IV Neonatal Intensive Care Unit. The primary outcome was tracheitis, defined by a combination of microbial, laboratory, or clinical evidence.

We identified 152 infants with a tracheostomy, of which 80 (52.6%) had post-operative tracheitis based on the study definition. Sixty-four (80%) infants with post-operative tracheitis had a positive tracheal colonization prior to tracheostomy. After controlling for demographics and variables associated with tracheitis in univariable analysis, days of pre-operative antibiotic administration was identified as protective against tracheitis (OR = 0.81, 95% CI = [0.69, 0.93], p = 0.004) in a multivariable analysis.

The incidence of tracheitis in this cohort of infants following tracheostomy placement was 52.6%. Obtaining pre-operative tracheal cultures and initiating prophylactic antibiotics if positive may help prevent post-operative tracheitis.